He Aifeng, Li Hongjing, Yang Shengkai, Xu Leiming, You Congliang, Li Suhui, Zhang Lulu, Zhang Chao
Binhai County People's Hospital, Kangda College of Nanjing Medical University, Yancheng, Jiangsu Province, China.
Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China.
Sci Rep. 2025 Aug 27;15(1):31613. doi: 10.1038/s41598-025-16724-9.
Atrial fibrillation is a common cardiac arrhythmia that significantly increases the risk of morbidity and mortality in critically ill patients. This study aimed to investigate the associations between glycemic control indicators-hemoglobin A1c (HbA1c), hemoglobin glycation index (HGI), stress hyperglycemia ratio (SHR), and glycemic variability (GV)-and clinical outcomes in AF patients admitted to intensive care unit (ICU). We conducted a retrospective analysis utilizing data from the Critical Care Medicine Information Marketplace (MIMIC)-IV database and a cohort from Binhai County People's Hospital, comprising patients with AF. Key endpoints included all-cause mortality during ICU stay and at 28-day post-ICU. Statistical analyses involved Kaplan-Meier survival curves, univariable and multivariable Cox regression models, smooth fitting curve, sensitivity analysis and weighted quantile sum (WQS) modeling. Finally, a total of 952 AF patients from MIMIC-IV database and 286 patients of Binhai People's Hospital due to AF were included for external verification. The results indicated that GV was the strongest predictor of mortality, with higher levels correlating with an increased risk of death (area under curve (AUC) = 0.620 for ICU mortality; AUC = 0.607 for 28-day post-ICU mortality). HGI and SHR also demonstrated significant associations with mortality outcomes, particularly in specific subgroups. Notably, lower HGI levels were linked to increased ICU mortality risk (log-rank P = 0.006). GV was the dominant factor in both outcomes and had a higher weight for death at 28 days after ICU (62.7% for ICU mortality vs. 47.3% for 28-day post-ICU mortality). These findings suggest that glycemic control is critical for improving outcomes in critically ill AF patients, highlighting the need for targeted interventions in managing hyperglycemia and its variability. Future studies should explore the mechanisms underlying these associations and assess the impact of glycemic management strategies on patient outcomes.
心房颤动是一种常见的心律失常,会显著增加重症患者的发病和死亡风险。本研究旨在调查入住重症监护病房(ICU)的房颤患者的血糖控制指标——糖化血红蛋白(HbA1c)、血红蛋白糖化指数(HGI)、应激性高血糖比率(SHR)和血糖变异性(GV)——与临床结局之间的关联。我们利用重症医学信息市场(MIMIC)-IV数据库的数据以及滨海县人民医院的一个队列进行了回顾性分析,该队列包括房颤患者。主要终点包括ICU住院期间及ICU出院后28天的全因死亡率。统计分析包括Kaplan-Meier生存曲线、单变量和多变量Cox回归模型、平滑拟合曲线、敏感性分析和加权分位数和(WQS)建模。最后,共纳入了来自MIMIC-IV数据库的952例房颤患者和滨海县人民医院的286例房颤患者进行外部验证。结果表明,GV是死亡率最强的预测指标,水平越高,死亡风险越高(ICU死亡率的曲线下面积(AUC)=0.620;ICU出院后28天死亡率的AUC=0.607)。HGI和SHR也与死亡结局显著相关,尤其是在特定亚组中。值得注意的是,较低的HGI水平与ICU死亡风险增加有关(对数秩检验P=0.006)。GV是两个结局中的主导因素,在ICU出院后28天死亡中的权重更高(ICU死亡率为62.7%,而ICU出院后28天死亡率为47.3%)。这些发现表明,血糖控制对于改善重症房颤患者的结局至关重要,凸显了针对高血糖及其变异性进行干预的必要性。未来的研究应探索这些关联背后的机制,并评估血糖管理策略对患者结局的影响。